|
Endovenous Laser Ablation of Varicose Veins |
|
|
Varicose veins are one manifestation of a medical condition called chronic venous hypertension (CVH). CVH may also lead to pain and swelling of the legs, leg ulcers and even blood clots. If you have CVH (which will be determined by a simple in-office ultrasound test), you may experience leg pain and swelling and you are at risk of developing leg ulcers and blood clots. Therefore, CVH should be treated so these complications do not develop. Untreated, CVH can lead to damage to the deep venous system as well, so to prevent damage extending to other veins, this condition should be treated promptly.
Spider veins may or may not be associated with CVH. Widespread spider veins should also be evaluated with duplex ultrasound examination. Treatment of the underlying CVH may decrease the number of spider veins or at least stop the development of new spider veins. Spider veins that are painful, usually are associated with underlying CVH.
If you have any of these conditions, evaluation with duplex ultrasound can provide valuable information that your physician will be able to use to assess your risk of other medical problems developing in the future.
Chronic venous hypertension is caused when one-way valves become damaged in the veins of the legs. Blood then moves down the vein into the legs instead of up toward the heart. For the largest veins, we use a laser inserted into the vein which seals it closed with heat. This is termed endovenous laser ablation or EVLA. Lasers use more heat than other treatments such as radiofrequency ablation, called VNUS, therefore, long term closure rates are 95% with laser EVLA and only about 83% with radiofrequency VNUS.
Before the procedure, you will be evaluated for medical problems and a duplex ultrasound examination will be performed to determine which veins in your legs have damaged valves. Your physician will review these results with you and together you will decide a course of treatment.
On the morning of the EVLA procedure, shower and eat normally. A driver is recommended to accompany you and drive you home because Valium may be administered to help relax you and open your veins. You will lie comfortably on a slanted surgical table equipped with a heating pad with your head higher than your legs. Music is available on an Ipod and a video screen is available in case you would like to watch the procedure.
The physician will perform the procedure under strict sterile conditions. The leg will be cleaned to maintain sterility and draped with a sterile cloth. When introducing the laser, you will feel a needle prick in your leg, much like having blood drawn from your arm. The laser will be inserted into your leg vein and its position checked with ultrasound. Then you will feel a series of numbing shots. After this, you will not be able to feel the laser energy and it will be turned on to seal the vein closed.
The entire process takes about 30 minutes and is very comfortable.
After the EVLA your leg will be bandaged and your compression stocking will be applied. It is strongly recommended that you walk for 30 minutes after the procedure and each day to prevent blood clots from forming. You are expected to wear the compression hose for 5 days continuously and for the next 14 days during the day only.
You will be checked with ultrasound a week after your procedure to ensure that the vein has remained closed and that no blood clots have formed.
If you have more than one vein requiring treatment, these will be done on subsequent days. After all the large veins have been treated with EVLA, the smaller veins will be treated with foam sclerotherapy . In this way, treating the largest veins first, many smaller veins and spider veins may clear up without additional treatment.
Ultrasound follow-ups are scheduled a month, three months, six months and a year after treatment to ensure continued success. If additional veins become incompetent, it’s best to treat them as soon as they are detected to keep you symptom-free.
<!--[if !vml]--><!--[endif]-->
|
